Individual
MARCUS KIM BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84112-8924
(801) 662-5702
Mailing address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84112-8924
(801) 662-5702
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
7148440-1205
UT
Other
Enumeration date
11/06/2008
Last updated
11/06/2008
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